Dealing with triage
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My last triage shift two babies with colds came in, stable vitals, low grade fevers. Both to the waiting room, and one was a 3, one was a four triage level. Obviously the three went in first, but the... Read More

I say, "you know sometimes patients don't look sicker but what if they actually told me that they have plans to kill everyone in the waiting room."

Don't think I won't use that one...LOL!

Jan 19, '13

You can follow up with the assault example, " assailants often follow their victims to the hospital. What if patient was assaulted? What if assailant followed? You wouldn't to see that in the waiting room!" Use away. I didn't copyright this stuff.

Jan 20, '13

Ideally, you perfect the art of being extremely nice AND extremely firm at the same time. I never give an estimate of a wait time, and I **confidently** explain that patients are seen not "in order" but by acuity.

Jan 20, '13

Triage can be frustrating. I am often assigned the "door whore" position. The triage nurse is looked at as the guardian to the er doors. Patients think that if they can woo us or intimidate us, we will let them through the magic gateway. My routine answer "patients are seen in order of acuity." End of discussion. If they want to argue with me, I refer them to the charge nurse, (which in many instances is me) or the nurse supervisor. I am too busy to stand and argue with anyone about their stuffy nose. I should note, that after triage, before the patient leaves the triage room, I let them know that all the rooms in the back are filled and we will bring them back as soon as an appropriate room is cleaned. I also tell them to let me know if they feel worse and that I will check on them periodically. Most people are okay with this. Of course, if they are truly acute, I bring them back and make room for them. I'm pretty thick skinned, so I don't let it get to me. Really, they are not attacking you personally, they are attacking the position and would be doing the same to anyone in triage that day.

Jan 21, '13

The "door whore" LOL!!

I don't think many of our patients know what acuity means. Literally. I have to say we see the sickest first.

Sadly, sometimes I agree with the complainers. Who wants to sit in a crowded waiting room with a cranky toddler for two hours, or maybe 4-5 hours? I have confidence that they will be fine (after 20-some years of nursing) but the parent is scared, thinking about leukemia or meningitis. My patients over 80 shouldn't be in a room with all the snot and germs, but they still get a "4" for that sore wrist.

I'm complaining about the inevitable! I was hoping all you smart people would have tricks to make it better.

Jan 21, '13

Our ED has a giant sign that basically states people are categorised and the people who are the sickest are seen first, also above the triage windows are signs saying 'you may think someone is jumping the queue but all patients are seen in order of need. '

Jan 21, '13

I wish triage was truly based only the RN's clinical judgment and objective data ie vitals. Sadly way too many people know the tricks - faking syncope, faking seizures, fake retching or self-induced vomit, screaming and yelling to the point where all other patients are glaring at you and would gladly give up their spots in line since they too all have headaches now, peeing in the waiting room, pacing around and around, and full-on badgering you until you want to send them back just to maintain your sanity. What truly annoys me is the violent and beligerent patients, most with alcohol on board - who make a huge scene and get taken back sooner for safety when there is really nothing at all wrong with them. Now the guy writhing with the kidney stone has to wait longer.
It took me a little while to trust my judgement, at first I would escalate almost anyone who complained, but then the volume we have been dealing with just got so out of control, that I learned I cannot just escalate everyone, and it must go only by acuity. I also find it really hard to stand my ground while to the rest of the patients/families waiting I look indifferent and uncaring, when they obviously have no idea what criteria I use to make my decisions.
It sounds like you really did the right thing. I know from experience it is really hard to deal with the "waiting room gang-up" but stick to your guns and trust your judgement. You were given this position because you are able to handle it!

Our ED has a giant sign that basically states people are categorised and the people who are the sickest are seen first, also above the triage windows are signs saying 'you may think someone is jumping the queue but all patients are seen in order of need. '

LOVE THIS IDEA!!! In my department this is also a huge problem, among others, so I had the idea to write up cards that adress the most common complaints, and hand them out to all patients on arrival to ED. My manager helped me get them approved all the way to the director of the hospital, they were printed up and everything. The problem is that no one hands them out, and even if they do, the patients do not read them. So much for that.

Jan 22, '13

I only did 4 hours as triage yesterday. Started off good, just several people.. Took em back to main ER.
Returned and my sign in basket exploded. 20 people walked in, nobody put time on sheets. The other staff try to go in order of arrival, I was going by complaint. Obviously I need to check in the pregnant gal doubled over and the chest pain before the gentleman who returned to get his stitches out..
These people come through the doors so often they know the 'routine' and I apparently broke it. Pt after pt coming to the window to tell at me that they were there first, why am I going in alphabetical order. All I said to them was that I was going by reason for visit.
It didn't help that the very last pt didn't want to wait so she came to the window all dramatic, complaining she can't breathe and thinks she's having a heart attack so I bring her right back. I swear she snickered at the people waiting. All the while chatting on her cell phone 'ill call you right back, I'm at the doctors office'. I guess if I had crack/cocaine on board Id feel like I was having a heart attack too

Triage can be frustrating. I am often assigned the "door whore" position. The triage nurse is looked at as the guardian to the er doors. Patients think that if they can woo us or intimidate us, we will let them through the magic gateway. My routine answer "patients are seen in order of acuity." End of discussion. If they want to argue with me, I refer them to the charge nurse, (which in many instances is me) or the nurse supervisor. I am too busy to stand and argue with anyone about their stuffy nose. I should note, that after triage, before the patient leaves the triage room, I let them know that all the rooms in the back are filled and we will bring them back as soon as an appropriate room is cleaned. I also tell them to let me know if they feel worse and that I will check on them periodically. Most people are okay with this. Of course, if they are truly acute, I bring them back and make room for them. I'm pretty thick skinned, so I don't let it get to me. Really, they are not attacking you personally, they are attacking the position and would be doing the same to anyone in triage that day.

If they want to argue with me, I refer them to the charge nurse, (which in many instances is me) or the nurse supervisor. I am too busy to stand and argue with anyone about their stuffy nose. I should note, that after triage, before the patient leaves the triage room, I let them know that all the rooms in the back are filled and we will bring them back as soon as an appropriate room is cleaned. I also tell them to let me know if they feel worse and that I will check on them periodically.

I'm pretty thick skinned as well.....they just aren't worth the time to get upset with...it's a hazzard of the job...pass it on to the super or charge.

very last pt didn't want to wait so she came to the window all dramatic, complaining she can't breathe and thinks she's having a heart attack so I bring her right back. I swear she snickered at the people waiting. All the while chatting on her cell phone 'ill call you right back, I'm at the doctors office'. I guess if I had crack/cocaine on board Id feel like I was having a heart attack too

People with crack cocaine on board have legitimate angina and are at a high risk for having an mi. Like it or not, she's got us there. For my money, canoe head, there are places that use a triage/float pool so that no one triages for more than four hours without taking a break to float. You could suggest to management if you are feeling frisky.

People with crack cocaine on board have legitimate angina and are at a high risk for having an mi. Like it or not, she's got us there. For my money, canoe head, there are places that use a triage/float pool so that no one triages for more than four hours without taking a break to float. You could suggest to management if you are feeling frisky.

I guess my sarcasm came because the dramatics at the window stopped as soon as I hit the button to open the doors.
The story changed once I got her back to the room.
I guess I just chuckle at how people gasp for air at the window like they just ran a marathon but are magically healed once the doors open.

I guess my sarcasm came because the dramatics at the window stopped as soon as I hit the button to open the doors. The story changed once I got her back to the room. I guess I just chuckle at how people gasp for air at the window like they just ran a marathon but are magically healed once the doors open.